Senate Finance Committee Wraps Up

October 5, 2009

The mission of the Academy is to be "indispensable to its members." One way the Academy fulfills this mission is by representing of neurology in the halls of Congress. Capitol Hill Report presents regular updates on legislative action and how the AAN ensures that the voice of neurology is heard on Capitol Hill. The Academy's legislative counsel in Washington, DC, Mike Amery, offers weekly updates on advocacy for neurology and neurologic concerns.

The Senate Finance Committee has approved a health reform proposal on a 14–9 vote on Tuesday, October 13. The bill will now be combined with a bill passed by the Senate Health, Education, Labor and Pensions (HELP) Committee before moving to the Senate Floor for debate.

After seven days of deliberations last week, the Senate Finance Committee wrapped up consideration of more than 500 amendments on a health reform measure. The final Senate bill contains:

A one-year 0.5 percent increase in physician reimbursement, but no permanent fix of the Sustainable Growth Rate (SGR) formula that determines physician reimbursement

Penalties for physicians who do not participate in the Physician Quality Reporting Initiative (PQRI)

A bonus for physicians providing primary care services (which does not include neurology as an eligible specialty)

An Independent Medicare Commission tasked with reducing Medicare physician spending by more than $10 billion over the next 10 years

Because of these provisions, the Senate legislation is unlikely to draw support from any physician specialties. In fact, there is an effort being put together to bring the physician specialty community and the American Medical Association together in a united front to oppose the bill. Even with this, the prospects for the legislation on the Senate floor look good, as Democrats control 60 votes needed to move the bill forward in the face of a Republican filibuster.

The US House has been waiting for Senate action before it moves forward with HR 3200. As reported in earlier posts, the House bill offers much more for physicians, including a permanent fix to the SGR that calls for cuts in reimbursement each year.

From the Academy's perspective, while weighing in with many other physician specialties on issues like SGR elimination, the Academy is focusing on ensuring that neurology is included in any bonus system for physicians providing primary care services. It appears that neurology was not included in the legislation because congressional staff were not aware that neurology is not a part of internal medicine, which is included. This leaves neurology as the only specialty that routinely provides high degrees of evaluation and management care of Medicare beneficiaries that is left out of the bonus provisions.

The House bill is headed to the House Rules Committee, which will put together the final package before it goes to the House floor. Amendments to the bill from any member of Congress can be considered in the Rules Committee. I met with Congresswoman Betty McCollum (D-MN) last week and she agreed to offer an amendment to add neurology, to the list of eligible specialties in section 1303 of HR 3200. This amendment will be "flagged" by Rules Committee member Ed Perlmutter (D-CO) to ensure (hopefully) its consideration before the committee. I will be meeting with Rules Committee staff throughout next week in an effort to raise awareness of the amendment and solicit support.

On the Senate side, we thought we had an agreement between Senate Finance Chair Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) to include neurology in the Senates bonus provision, but that unfortunately fell through when Sen. Grassley opposed the Baucus drafted bill. We will now pursue an amendment on the Senate floor, and are working with Sen. Grassley's office and with Sen. Amy Klobuchar (D-MN).

Finally, although these bills are moving forward, there remains the significant hurdle of consideration for a public health insurance option. The Senate bill provides for a health insurance exchange that is supposed to facilitate competition and lower costs, rather than a public option. The Finance Committee turned back two amendments that would have replaced the exchange with a public option. In both cases, committee chair Baucus voted "no," saying there is no possibility of getting 60 votes on the Senate floor for a bill containing a public option. The same debate continues to rage among House Democrats, with the Blue Dog Coalition of 52 conservatives opposing a public option squaring off against an even larger number of members of the House Progressive Caucus who demand a "robust" public option. Democrats need 218 votes to pass a health reform bill. The loss of 40 Blue Dogs or Progressives would doom the bill, as no Republicans are likely to support the final bill.